Why Isn’t My “Free” Preventive Health Care Free?

In my opinion, one of the best changes made by the Affordable Care Act is the mandate that requires health plans to provide certain specified preventive services without imposing any cost sharing.  This is sometimes referred to as “free” preventive care.  As a result of this mandate, deductibles, copays, coinsurance, and other cost sharing may not be imposed on the specified preventive services if they are provided by an in-network provider. 

The thing that is so great about free preventive care is that it results in better health outcomes for employees and their families, while, at the same time, saving employers from paying larger health claims when illnesses are not diagnosed early.  Read More ›

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Curing What Ails You – Relief for Small Employer HRAs

The impact of the Affordable Care Act (“ACA”) on health reimbursement arrangements (“HRAs”) has not been favorable.  Many employers got rid of their HRAs or integrated them with a major medical plan in order to avoid significant penalties under ACA.  These rules imposed a significant burden on small employers, because many small employers used HRAs to reimburse employees for the cost of individual health insurance policies they purchased rather than sponsor a group health plan.

In IRS Notice 2015-17, Q&A1, the IRS granted limited relief for small employer HRAs through June 30, 2015.  However, at the end of last year, small employers received greater relief in the form of the 21st Century Cures Act (the “Cures Act”). Read More ›

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Making a List, Checking it Twice

It’s that time of year when boys and girls start making their lists for the holidays, but we in the employee benefits world make a very different kind of list.  In the rapidly changing world of employee benefits and executive compensation law, a checklist can be particularly helpful to make sure important issues do not fall through the cracks.  Each year we publish an executive compensation checklist, a health and welfare plan checklist, and a qualified retirement plan checklist to help individuals stay apprised of changes in the law, changes that they might need to make to their employee benefits plans, and various notice requirements.  Read More ›

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Dealing with Long-Winded Out-of-Network Provider Nuisance Letters

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims.  The letters are usually 20 to 30 pages long, not very specific, and make various accusations against the plan and its fiduciaries. 

Most of the letters follow a standard approach.  They start by alleging breaches of fiduciary duty, they request all sorts of plan documents, and they request additional appeals to which the participant may or may not be entitled.  The biggest problem is that these letters are never very specific in exactly what they want.  Instead, they make vague accusations, and hope some or all will stick. Read More ›

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What is Telemedicine? A Cool Benefit or a Hot Mess?

We’ve had numerous inquiries lately about telemedicine benefits.  My clients most typically ask either “is this a group health plan?” or “is it just access to another provider?”  Clearly, there is much confusion surrounding telemedicine benefits.  Part of the problem is that the regulators have yet to issue guidance on how telemedicine should be treated.  All we can do is take what is a very innovative benefit and figure out how it fits into a complicated, and sometimes outdated, regulatory framework.

Let’s start by agreeing that telemedicine benefits are pretty cool.  With telemedicine, employees can usually see a doctor sooner than if they had to go to a doctor’s office.  Read More ›

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When Anything Less than 95% is a Failing Grade: An Update on the Employer Shared Responsibility Penalties

As a reminder, effective January 1, 2016, employers must offer minimum essential coverage to 95% or more (up from 70% or more for 2015) of their full-time employees and their dependents each month or pay a very steep penalty.  Missing the mark even slightly, for example coming in at 94%, will require the employer to pay a $2,000 annual penalty for each full-time employee (minus the first 30 full-time employees).

The rules are explained in more detail in our Health Care Reform’s Employer Shared Responsibility Penalties: A Checklist for Employers, which I have updated to reflect certain recent guidance.  Most importantly the revised Checklist:

  •  now reflects how the penalties are adjusted each year (see footnote 7 of the Checklist for more information);
    • the $2,000 subsection (a) penalty is $2,080 for 2015 and $2,160 for 2016.
Read More ›
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Late Or Incorrect Forms 1095-C: The IRS Provides Relief, But Only For Employers Acting In Good Faith To Comply Or Who Missed The Deadline Due To Reasonable Cause

Many employers struggled to furnish correct Forms 1095-C to employees by the March 31, 2016 deadline.  Section 6721(a)(2) of the Internal Revenue Code provides penalties for failure to furnish Forms 1095-C to individuals by the deadline.  Although the presumptive penalty is $250 for each delinquent or incorrect return, the penalty amount may be reduced if Forms are furnished or corrected within 30 days of the filing deadline.  Correction within 30 days lowers the presumptive penalty to $50 per return.  If a failure to correct is not made within 30 days, but is made by August 1, the presumptive penalty is reduced to $100 per return.  Read More ›

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If You Blinked You Might Have Missed Important Affordable Care Act Guidance

Notice 2015-87 issued by the IRS on December 16, 2015, provides guidance on numerous Affordable Care Act provisions.  Below are some of the highlights.

  • The Notice provides additional guidance on integrating health reimbursement arrangements (“HRAs”) with major medical plans, as originally explained in IRS Notice 2013-54.  See Q&As 1-4.
  • It provides further guidance on arrangements under which an employer reimburses an employee for some or all of the premiums for an individual insurance premium.  See Q&As 5-6.
  • Part III of the Notice clarifies certain aspects of the employer shared responsibility provisions of Code Section 4980H, including identification of employee contributions when employers offer HRAs, flex credits, opt-out payments, or fringe benefit payments required under the McNamara-O’Hara Service Contract Act.
Read More ›
Posted in Employee Benefits, Health & Welfare Plans, Health Care Reform

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Check(list) It Out!

Who doesn’t love a good checklist?  I know I do.

In the rapidly changing world of employee benefits and executive compensation law, checklists can be particularly helpful to make sure important issues don’t fall through the cracks.   To help folks stay apprised of changes in the law, changes they might need to make to their employee benefit plans, and various notice requirements, each year we publish a health and welfare plan checklist, a qualified plan checklist, and an executive compensation checklist.

We just published the last of the three checklists.  In case you missed them, links to each checklist are below.  Read More ›

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EEOC Ruling on Sexual Orientation Impacts Same-Sex Spouse and Domestic Partner Benefits

In our July 2, 2015 blog, Obergefell v. Hodges – Same-Sex Marriage Now Legal in All 50 States, we indicated that employers may need to offer same-sex spouse health and welfare benefits and rethink domestic partner benefits in order to avoid discrimination claims.  Shortly after posting that blog, the Equal Employment Opportunity Commission (the “EEOC”) ruled that an allegation of sexual orientation discrimination inherently constitutes sex-based discrimination under Title VII of the Civil Rights Act.  See Complainant v. Foxx, EEOC Agency No. 2012-24738-FAA-03 (July 16, 2015).  While the EEOC’s ruling is not binding on private employers, employers should be aware that courts may give weight to the EEOC’s viewpoint. Read More ›

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